What can cause leg pain
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Information, in part, from the Arthritis Foundation
An assortment of conditions cause leg pain.
Claudication typically occurs during physical activity such as walking and is relieved by a brief rest. Normally, blood flow can increase to meet the increased need for additional oxygen in exercising muscles. However, when the leg arteries are blocked, blood flow cannot increase in response to exercise. Pain develops. Claudication pain always involves the same muscle groups, usually the calves. The severity of claudication pain is sometimes gauged by walking distance in terms of street blocks (e.g. “2-block claudication”) or distance traveled before the symptom occurs.
As atherosclerosis progresses and blockage becomes more severe, a burning/aching pain in the feet and toes will occur at night. This pain, known as rest pain, occurs because the arteries of the leg can no longer deliver enough blood flow to the feet, even at rest. Rest pain generally worsens when the legs are elevated, eg.,when lying in bed at night. Relief from this pain may occur only when the feet are dangled.
Arterial insufficiency from atherosclerosis is termed peripheral artery disease (PAD).
Gangrene may occur when extensive arterial narrowing (stenosis) or complete blockage (occlusion) of lower extremity arteries occurs.
An acute arterial clot- called an embolus- is a surgical emergency. A patient will develop the sudden onset of a painful, cold, blue leg.
When veins and lymphatics don’t return blood from the legs back to the heart properly, venous stasis can develop. Patients begin to develop swelling, pain, and discoloration of the legs. Sometimes a clot can form. This is a particularly dangerous situation that is referred to as thrombophlebitis. Patients should be evaluated with a Doppler flow study. They may need to be treated with anticoagulation therapy.
70% of older adults experience Benign Nocturnal Leg Cramps. Leg cramps occur when an involuntary contraction of the calf muscle causes an intensely painful spasm. Pain can be mild to severe. Some people have frequent episodes while others have occasional ones. The cause of benign leg cramps is unknown. However dehydration may play a role and leg cramps can be a side effect of many medications. Underlying medical problems, such as thyroid disease, may also contribute to the problem.
These usually awaken the sufferer with a spasm-like pain in the calf. This is called a "charley horse." The episode lasts a few seconds or minutes and may occur again during the night. Some bouts of leg cramps occur frequently over many weeks and months, while other people have sporadic occurrences. They may occur with strenuous exercise, when using a group of muscles repetitively, or when circulation is restricted from sitting awkwardly. Most cramps last only a few seconds, and at most a few minutes. Leg cramps are particularly common in pregnant women and the elderly.
Some of the following remedies can help relieve leg cramps:
- Drink six to eight glasses of water daily.
- Stretch calves regularly throughout the day and again at night.
- While lying in bed, gently pull toes toward knees. Do not let feet point down.
- Sleep under loose covers that make it less likely to point your toes.
- Place a pillow at the end of the bed to prop up feet.
- Lie on the stomach with feet hooked over the edge of the bed.
To relieve a cramp, extend the leg and flex foot toward the head. Also, gently stretch the calf by standing up, bending the affected leg at the knee and putting weight on the leg for several minutes. Massage the muscles that are in spasm or apply heat or cold to ease pain.
Sometimes, a small glass of tonic water at bedtime can prevent these cramps from occurring.
Low back pain and leg pain that is not relieved by lying down may be caused by a tumor in the cauda equina (the roots of the spinal nerves controlling sensation in and movement of the legs), or a cancer that has spread to the spine from the prostate, breasts, or lungs. Bone tumors such as chondrosarcomas and osteosarcoma as well as rare malignancies of muscle such as rhabdomyosarcoma can also cause leg pain.
Stress fractures of the bones in the legs can cause pain and may be unsuspected in patients with no prior history of significant trauma. Patients with osteoporosis are at increased risk.
Disk herniation is a disorder in which a disk begins to bulge outward between the vertebrae. Herniated or ruptured disks are a relatively common cause of chronic low back pain in adults. The pain from herniated disc is referred to as sciatica. Sciatica rarely causes leg pain at night.
Back and leg pain that is out of proportion to a minor injury, or that is unusually prolonged, may be associated with a somatoform disorder or other psychiatric disturbance.
Low back pain with leg involvement
As noted earlier, low back pain that radiates down the leg usually indicates involvement of the sciatic nerve. The nerve can be pinched or irritated by herniated disks, tumors of the cauda equina, abscesses in the space between the spinal cord and its covering, spinal stenosis, and compression fractures. Some patients experience numbness or weakness of the legs as well as pain.
Conditions where muscle has been traumatized and swells can lead to “compartment syndrome.” This problem is due to the fact that the leg tissues are constrained by fascial compartments. If there is swelling of tissue because of injury, blood vessels become compressed, blood flow decreases markedly, and the leg can become painful. In serious cases, the muscle becomes necrotic and dies.
Infections of skin, blood vessel, muscle or any tissue in the leg can lead to swelling and pain. Severe infections can cause a condition called "necrotizing fasciitis." This is the condition that is caused by "flesh-eating bacteria."
This is another cause of leg pain at night. Generally, though, there is pain involving other areas in addition to the leg.
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